Provider Demographics
NPI:1881634152
Name:TENDER LOVING CARE HEALTH CARE SERVICES OF FLORIDA, LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES OF FLORIDA, LLC
Other - Org Name:TENDER LOVING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WIKLLARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-358-1000
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:516-358-1000
Mailing Address - Fax:516-327-8636
Practice Address - Street 1:VILLAGE GREEN 9342 US 1
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-335-3255
Practice Address - Fax:772-335-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA2114096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107140Medicare ID - Type Unspecified